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Background The number of bilingual people increases worldwide. In Sweden, one-third of all preschool age children are bilingual. Previous studies reported that bilingual children are at risk of being overlooked for early identification of language difficulties. There is a need of validated assessment instruments for identification of language disorder in bilingual children. Aim To investigate whether the language screening for three-year-olds used in Swedish Child healthcare would detect developmental language disorder (DLD) in bilingual children 6 month earlier. Methods Overall, 111 bilingual children (51% girls), 29-33 months, were screened from November 2015 to June 2017. They were recruited from three child health centres serving areas of low socio-economic status in Gävle, Sweden. The children were screened both in their mother tongue and in Swedish at the child health centre and consecutively assessed for DLD by a speech and language pathologist, blinded to the screening outcomes. Results Preliminary results from combining screening in Swedish and the child's mother tongue showed good accuracy: 88% sensitivity, 82% specificity, 67% positive and 94% negative predictive values. DLD was confirmed in 32 children (29%), of which 87.5% had screened positive and 12.5% negative. Specificity and positive predictive value increased radically when both languages were assessed, whereas sensitivity was less affected. A majority of the children who did not cooperate in the screening turned out to have DLD. Conclusions A language screening should be performed in the child's both languages, in order to achieve adequate sensitivity, specificity and positive predictive value. This procedure is highly relevant for children from low socio-economic families with a complex linguistic environment who tend to be at an increased risk of severe DLD. Key messages The procedure combining the child’s two languages identified language disorder in bilingual children at age 2.5 compared with assessment in only one language. Child healthcare nurses should screen bilingual children in both their languages in order to reflect their full language capacity equally as in monolingual children.

Identifying language disorder in bilingual children is possible only if both languages are assessed